Causes of kidney disease include deposition of the
Immunoglobulin A antibodies in the
glomerulus, administration of
analgesics,
xanthine oxidase deficiency,
toxicity of
chemotherapy agents, and a long-term exposure to
lead or its salts. Chronic conditions that can produce nephropathy include
systemic lupus erythematosus, as well as
diabetes mellitus and
high blood pressure (hypertension), which lead to
diabetic nephropathy and
hypertensive nephropathy, respectively.
Autosomal dominant polycystic kidney disease Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disease, affecting a half million Americans. The clinical phenotype can result from at least two different gene defects. One gene that can cause ADPKD has been located on the short arm of chromosome 16.
IgA nephropathy IgA nephropathy is the most common
glomerulonephritis throughout the world Primary IgA nephropathy is characterized by deposition of the
IgA antibody in the glomerulus. The classic presentation (in 40–50% of the cases) is episodic frank
hematuria which usually starts within a day or two of a non-specific
upper respiratory tract infection (hence
synpharyngitic) as opposed to
post-streptococcal glomerulonephritis which occurs some time (weeks) after initial infection. Less commonly gastrointestinal or urinary infection can be the inciting agent. All of these infections have in common the activation of mucosal defenses and hence IgA antibody production.
Polycystic disease of the kidneys Additional possible cause of nephropathy is due to the formation of cysts or pockets containing fluid within the kidneys. These cysts become enlarged with the progression of aging causing renal failure. Cysts may also form in other organs including the liver, brain, and ovaries. Polycystic kidney disease is a genetic disease caused by mutations in the PKD1, PKD2, and PKHD1 genes. This disease affects about half a million people in the US. Polycystic kidneys are susceptible to infections and cancer.
Xanthine oxidase deficiency Another possible cause of Kidney disease is due to decreased function of
xanthine oxidase in the
purine degradation pathway. Xanthine oxidase will degrade
hypoxanthine to
xanthine and then to
uric acid. Xanthine is not very soluble in water; therefore, an increase in xanthine forms crystals (which can lead to
kidney stones) and result in damage to the kidney.
Xanthine oxidase inhibitors, like
allopurinol, can cause nephropathy.
Diabetes Diabetic nephropathy is a progressive kidney disease caused by
angiopathy of the
capillaries in the
glomeruli. It is characterized by
nephrotic syndrome and diffuse
scarring of the glomeruli. It is particularly associated with poorly managed
diabetes mellitus and is a primary reason for
dialysis in many developed countries. It is classified as a
small blood vessel complication of diabetes.
Lupus Despite expensive treatments,
lupus nephritis remains a major cause of morbidity and mortality in people with relapsing or refractory lupus nephritis.
COVID-19 COVID-19 is associated with kidney disease. In patients hospitalized with COVID-19, the
prevalence of acute kidney injury is estimated to be 28%, and the prevalence of
renal replacement therapy is estimated to be 9%.
Analgesics One cause of nephropathy is the long term usage of pain medications known as
analgesics. The pain medicines which can cause kidney problems include Tylenol,
aspirin,
acetaminophen,
paracetamol, and
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. This form of nephropathy is "chronic analgesic nephritis" or Analgesic Nephropathy, and inflammation (BRS Pathology, 2nd ed.). Specifically, long-term use of the analgesic
phenacetin has been linked to
renal papillary necrosis (necrotizing papillitis).
Toxicity of chemotherapy agents Nephropathy can be associated with some therapies used to treat cancer. The most common form of kidney disease in cancer patients is
acute kidney injury (AKI) which can usually be due to volume depletion from vomiting and diarrhea that occur following chemotherapy or occasionally due to kidney toxicities of chemotherapeutic agents. Kidney failure from break down of cancer cells, usually after chemotherapy, is unique to
onconephrology. Several chemotherapeutic agents, for example
cisplatin, are associated with acute and chronic kidney injuries. Newer agents such as
anti-vascular endothelial growth factor (anti-VEGF) are also associated with similar injuries, as well as
proteinuria,
hypertension, and
thrombotic microangiopathy.
Lithium Lithium, a medication commonly used to treat
bipolar disorder and
schizoaffective disorders, can cause
nephrogenic diabetes insipidus; its long-term use can lead to nephropathy. Long term
lithium treatment is known to cause chronic kidney disease after 10-20 years of treatment in 1-5% of people. End-stage renal disease due to lithium occurs in 0.53% of people versus 0.2% in the general population. Dosing lithium more than once per day is associated with more kidney damage. Kidney harm can be mitigated by dosing lithium once per day at night and keeping the dose as low as possible. Dosing lithium once per day allows for long periods where the kidney is exposed to low levels of lithium, which minimizes kidney harm.
Anabolic-androgenic steroids Regular and long-term use of
anabolic-androgenic steroids (AAS) can cause both acute and chronic kidney disease through several direct and indirect mechanisms.
Focal segmental glomerulosclerosis is the most common condition arising in such cases. Discontinuation of AAS in the early stage of Kidney Disease can result in a reversal of the kidney damage.
Diet Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for
microalbuminuria, a sign of kidney function decline, and generally, diets higher in fruits, vegetables, and whole grains but lower in meat and
sweets may be protective against kidney function decline. This may be because sources of animal protein, animal fat, and cholesterol, and sweets are more acid-producing, while fruits, vegetables, legumes, and whole grains are more
base-producing. ==Diagnosis==